Question
QUESTION: On January 2nd, 2008 my husband and I were in a motorcycle accident. My husband suffered pulled muscles in his back, but I had a broken collar bone.  For the last month or so I have had numbness and tingeling in my arms and hande.  It now has gone to my feet.  I found out (finally) I have a crushed vertibra in my neck.  How important is it I get attention soon?  What should I expect?  I only had a MRI of my neck.  Should I have more tests?  Thank You!!

ANSWER: Hello Lonna,

January 2, 2008 Motor Vehicle Accident, 'crushed' (fractured) vertebrae, How important to get attention?, on June 10, 2008?

Certainly it is urgent to have neurological and orthopedic evaluations.  Urgent, not emergent.  You have lived with this for over 6 months, how did you not know of the crushed vertebrae?  What emergency room did you go to?  What treating doctors have you seen?

In 6 months since the injury, certainly the bone is healing, indeed is pretty much healed. At the time of injury, evaluation should have found this condition and at that time perhaps some type of bracing, support, immobilizer could have been helpful.  At that time, some type of treatment could have been indicated and initiated.  At this time, certainly more imaging must be done: MRI , CT scan should be performed, not only to evaluate you now, but to compare with the previous studies.  

A 'crushed' vertebrae is often (as must have happened in your case) stable- meaning that it is not in imminent danger of severing the spinal cord or spinal nerves.  However any fracture is evidence of severe trauma, severe force.  That crushed bone will heal, such is the nature of life, but it may heal in such a fashion that it irritates nerves or the cord itself.  OsteoArthritic degeneration is expected after such a severe trauma.  Proper treatment could slow or stop this development.

Fractures are usually not treated by the Doctor of Chiropractic.  AFTER healing has taken place, chiropractic evaluation and treatment will be helpful to properly align the joints and slow degeneration of the associated joints.

Twenty-five years ago my mother was involved in an automobile accident here on Staten Island.  She sustained a spinal fracture.
Her injury was down in the lower back, at the second lumbar vertebrae.  The type of fracture sustained has a name- called a 'seat belt fracture'.  Mom was a passenger in the car, and the seatbelt was either not properly placed, or slipped during the MVA (motor vehicle accident ).  When you wear a seat belt properly, it should go over the big bones of your pelvis, if you place the seatbelt too high- across the belly- when you are restrained you can bend in half like a jack-knife dive.  That pressure of the seat belt pressing into your belly, with the jack knife (toe touch) type of position forced upon the body can compress ( 'crush' ) the spinal bone (vertebrae).

The emergency room doctors misread her xrays and tied her head down for a (mis)diagnosed cervical fracture  ( cervical bone spurs from YEARS of stiff necks that she ignored - - until I became a Doctor of Chiropractic).  While immobilizing her neck- over her objections- they disregarded her complaint of severe lower back pain.  Ultimately more experienced doctors and a radiologist reviewed all of her Xrays, removed the c-spine immobilization and correctly diagnosed the lumbar fracture.  Twenty-five years ago they gave Mom the option to: lay flat on her back in bed in the hospital for 6- 8 weeks,,, or to lay flat on her back in bed at home for 6- 8 weeks.  Mom went home, I visited twice daily, gave a ton of Nutritional support, Adjusted the cervical and thoracic spines, gave a ton of therapy (at least 2x per day) to the fracture site.  Mom's lower back healed perfectly.  She has little or NO lower back complaints.

NO low back pain because the broken bone, the fracture, the 'crushed' vertebrae, the stable compression fracture was treated correctly from day one.

Mom still has neck problems.  Stiff necks, occasional pinched nerves from sleeping wrong.  Never fractured her neck,,,, but had years of neck problems THAT WERE NOT TREATED PROPERLY; so her neck causes her more problems than her lower back - -  which she fractured !!!

Prompt appropriate care gives the best outcome.  You are well along in the process.  Certainly I would have liked to have seen prompt better care.  But, no use crying over spilled milk.  The time is now. Please visit the Neurologist (to evaluate nerve involvement), the Orthopedist (for bone and joint evaluation, possible prescription for physical therapy), and your local family Doctor of Chiropractic for an evaluation and chiropractic intervention that may be indicated.

Numbness and tingling indicate neuro-vascular involvement.  Given your history, it is probably neurological, probably at your cervical spine, possibly involving cord pressure.

Yes, appropriate evaluation and perhaps intervention is urgent. You do not have to go to the emergency room, but  Please call and consult with the disciplines mentioned above.

As always, this article is for discussion purposes only.  Specific evaluation, DX, RX, TX, PX can only be given by a treating health professional in person.

This is your Staten Island Chiropractor, Dr. Victor Dolan ,wishing you good luck and good health naturally.

http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com    (email newsletter)









---------- FOLLOW-UP ----------

QUESTION: Dr. Dolan,
That was my question also.  The accident was Jan. 2nd.  I went to the ER and they seen my collar bone right away, and took for granted that was all that was wrong obviously.  Nothing more was done, but a sling was put on my arm, and told tosee an Ortho doctor when I got home (a weeks drive in our condition).  The ortho doctor put a pin in my collar bone, and then 16 weeks later took it out. Bu then I was feeling the tingeling in my arms and hands.  He pretty much told me it was in my head.  A couple of weeks ago I went to my diabetic doctor (I am a type 1 diabetic) and asked him if it were from the diabetes, he said no.  So I pushed him into doing the MRI of my neck.  I found out the results of the MRI being a crushed vertibra in my neck and pinching on the nerve, last Friday June 6th.  I have had the MRI sent to a Neuralsergeon, and am awaiting his responce.  My thing is I am feeling that I should have been checked out thourally at one time or another by now, shouldn't I?  Considering I was in a motorcycle accident at 65 MPH shouldn't there have been more tests, and something done right away? And the waiting for7-10 days each time?  Should I drive, and go back to work?  I am sorry, but I have a lot of questions that I can't seem to get answered.  
Thank You for your help!
Lonna

Answer
Crushed vertebrae, compression fracture, tingling, numbness, pinched nerve, MRI, neurosurgeon, herniated disc.

Hello Lonna,

I do not wish to add fuel to your fire, but it does seem as though you were not evaluated thoroughly initially.  As a Doctor of Chiropractic my opinion would have little or no impact (legally) commenting upon the medical or hospital procedures that did (or did not) fully evaluate you at the time of the motor vehicle accident
( MVA ).  I have ridden an ambulance as a certified emergency medical technician ( EMT ) both as a volunteer and a paid member responding to 911 emergency calls in NYC.  I have a diplomat in sports injuries
( DACBSP ), I place myself on the field, at events, sometimes as the only health professional.  Many Doctors of Chiropractic ( DCs ) have not handled as much trauma as I have,  and given your subjective report; it does seem that you may be suffering now from an injury received in the MVA that was not fully evaluated.

There is no use crying over spilt milk,  you have to do what you can to stay as healthy as possible and regain as much health as possible.

As discussed previously, you need further imaging, MRI, CT scan, perhaps myelogram; diagnostic testing EMG/ncv; an orthopedic and neurological evaluation from the respective specialists.  You should see a Doctor of Chiropractic for evaluation and possible TX.  Any, all of these doctors after reviewing your case should be able to help you physically, health wise.  Comparing films/ tests from the emergency department  ( now a days hospitals have 'EDs' emergency departments,,, 'ER'- emergency room is sort of an old term now ), will show if proper workup was done and if degeneration or change is taking place.  Get comments from your treating doctors, ASK questions of your treating doctors.  Progressive tingling, progressive numbness can come from many causes and must be evaluated.  Given the scenario you have described, your progressive neurological signs and symptoms are probably coming from the neck injury ( but other possibilities must be ruled out ).

Activity? - should you drive, go back to work ?  Well, it is June 11 and your motor vehicle accident was January 2,,, what activities have you returned to?  What activities seem prohibited by your condition?
You may be able to return to work - - what kind of work do you do ?
You may be able to drive - -can you turn your head enough to be able to see, does the tingling in your arms or legs interfere with driving strength or acuity?  It sounds as if you are injured.  YOU have to be the squeaky wheel, YOU have to get to doctors,  YOU have to communicate with them your concerns.  The squeaky wheel gets the attention it needs.  I would not return to the hospital or doctors that treated you initially.  I would not go to doctors affiliated with the hospital or affiliated with the doctors that treated you initially, you may have some uncomfortable, tough questions for 'friends' of the initial facility.

I hope this helps.  This staten island chiropractic sees a lot of patients from staten island accidents.  Sometimes the workup has been more than thorough, sometimes not.  A compression fracture ( 'crushed' vertebrae )- my assumption , is also enough force to herniate a disc, pinch a nerve, cause neurological damage.

Take the effort to be the squeaky wheel, get the diagnositc workup you need, get the treatment you need, get the answers you need.

Wishing you good luck and good health naturally, your staten island chiropractor,

Dr. Victor Dolan , DC
http://www.GoodHealthNaturally.info
http://www.DocDolan.net
Http://drvictordolan.chiroweb.com  (email newsletter)